Stimulating the Need to Know…

Nations, James D. Tropical Rainforest: Endangered Environment . New York: Franklin Watts, 1988. 143 pp. $12.90 hardcover. Reviewed by Jorge Zamacona Evenes.

Sharp, D.W.A., ed. The Penguin Dictionary of Chemistry , 2d ed. New York: Penguin, 1990. 434 pp. $9.95 paperback. Reviewed by Wayne Hanley.

Hale, W.G., and J.P. Margham. The HarperCollins Dictionary of Biology. New York: Harper Collins, 1991. 569 pp. $12.95 paperback; $25.00 hardcover. Reviewed by Wayne Hanley.

Sparks, John, and Tony Soper. Penguins. New York: Fact On File, 1987. 246 pp. $1995 hardcover. Reviewed by Wayne Hanley.

Mountfort, Guy. Rare Birds of the World . A Collins/ICBP Handbook. New York: Penguin (The Stephen Greene Press), 1988. 256 pp. $2995 hardcover. Reviewed by John W. McLure.

Woodcock, Martin. Collins Handguide to the Birds of the Indian Subcontinent . New York: Penguin (The Stephen Greene Press), 1989. 176 pp. $11.95 paperback. Reviewed by James Scheib.

Harris, Michael. The Collins Field Guide to the Birds of Galapagos . New York: Penguin (The Stephen Greene Press), 1989. 160 pp. $1995 hardcover. Reviewed by Jim Fuller.

Brudenell-Bruce, P. G. C. The Collins Guide to the Birds of New Providence and the Babama Islands. New York: Penguin (The Stephen Greene Press), 1989. 142 pp. $14.95 paperback. Reviewed by Carol A. Thompson.     

Chirality and Drugs Used in Psychiatry: Nice to Know or Need to Know?

1. Many drugs used to treat psychiatric disorders contain a chiral center or a center of unsaturation and are marketed as a mixture of the resultant enantiomers or geometric isomers, respectively. These enantiomers or geometric isomers may differ markedly with regard to their pharmacodynamic and/or pharmacokinetic properties.2. Examples of the effects of chiral centers or geometric centers on such properties are given for drugs from the following classes: antidepressants (tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, viloxazine, bupropion, trazodone, mianserin, venlaflaxine); benzodiazepines, zoplicone, and antipsychotics.3. As described in this review, there are several notable examples of psychiatric drugs currently available where the individual enantiomers or geometric isomers differ considerably with regard to factors such as effects on amine transport systems, interactions with receptors and metabolizing enzymes, and clearance rates from the body. Indeed, relatively recent developments in analytical and preparative resolution of racemic and geometric drug mixtures and increased interest in developing new drugs which interact with specific targets, which have been described in detail at the molecular level, have resulted in increased emphasis on stereochemistry in drug development.     

Mangrove Restoration: Do We Know Enough?

Mangrove restoration projects have been attempted, with mixed results, throughout the world. In this paper, I first examine goals of existing mangrove restoration projects and determine whether these goals are clear and adequate, and whether or not they account for the full range of biological diversity and ecological processes of mangrove ecosystems. Many restored mangrove forests resemble forest plantations rather than truly integrated ecosystems, but mangrove plantations can be a first step toward mangrove rehabilitation. Mangrove restoration projects that involve associated aquaculture or mariculture operations tend to be more likely to approximate the biological diversity and ecological processes of undisturbed mangrove ecosystems than are projects that focus only on the trees. These integrated restoration projects also provide a higher economic return than do silvicultural projects alone. Second, I briefly assess whether existing ecological data are sufficient to undergird successful restoration of mangal and define criteria for determining whether or not a mangrove ecosystem has been restored successfully. These criteria include characteristics of vegetation (forest) structure, levels of primary production, composition of associated animal communities, and hydrology. Finally, I suggest ways to improve mangrove restoration projects and identify key research needs required to support these efforts. Ecological theories derived from other wetland and upland systems rarely have been applied to either “basic” or “applied” mangrove forest studies, to the detriment of restoration projects, whereas lessons from restoration of the relatively species‐poor mangrove ecosystems could be beneficially applied to restoration projects in other contexts. An international database of mangrove restoration projects would reduce the likelihood that unsuccessful restoration projects would be repeated elsewhere. Clear criteria for evaluating success, greater accessibility of information by managers in the developing world, intensified international cooperation, and application of relevant ecological theories will improve the success rate of mangrove restoration projects.     

WORKMEN'S COMPENSATION ACT—Some Aspects of Interest to California Physicians

This article was prepared by Mr. William M. Whelan, Director of Special Services, California Medical Association, under the supervision of Dr. Francis J. Cox, Chairman of the Medical Services Commission of the Association, and Mr. Howard Hassard, the Association''s Legal Counsel. It is intended as a brief synopsis of the California Workmen''s Compensation Law as it applies to the physician in private practice. It is not an exhaustive treatment of the subject. A physician who desires to acquaint himself in detail with California industrial practice should consult the article entitled “The Physician''s Role in Workmen''s Compensation,” California Medicine, 82:352-362, April, 1955. Inquiries regarding industrial medicine should be addressed to Mr. William M. Whelan, California Medical Association, 450 Sutter St., San Francisco 8.     

What Do We Really Know about Cellulose Biosynthesis in Higher Plants?

Cellulose biosynthesis is one of the most important biochemical processes in plant biology. Despite the considerable progress made during the last decade, numerous fundamental questions related to this key process in plant development are outstanding. Numerous models have been proposed through the years to explain the detailed molecular events of cellulose biosynthesis. Almost all models integrate solid experimental data with hypotheses on several of the steps involved in the process. Speculative models are...     

Survey of Physicians’ Perspectives and Knowledge about Diagnostic Tests for Bloodstream Infections

Background

Physicians rely on blood culture to diagnose bloodstream infections (BSI) despite its limitations. As new technologies emerge for rapid BSI diagnosis, optimization of their application to patient care requires an understanding of clinicians’ perspectives on BSI diagnosis and how a rapid test would influence medical decisions.

Methods

We administered a 26-question survey to practitioners in infectious diseases/microbiology, critical care, internal medicine, and hematology/oncology services in USA and Germany about current standards in diagnosing and treating BSI and a hypothetical rapid BSI test.

Results

Responses from 242 providers had roughly equal representation across specialties. For suspected BSI patients, 78% of practitioners would administer empiric broad spectrum antibiotics although they estimated, on average, that 31% of patients received incorrect antibiotics while awaiting blood culture results. The ability of blood culture to rule in or rule out infection was very/extremely acceptable in 67% and 36%, respectively. Given rapid test results, 60–87% of practitioners would narrow the spectrum of antimicrobial therapy depending on the microorganism detected, with significantly higher percentages when resistance determinants were also tested. Over half of respondents felt a rapid test would be very/extremely influential on clinical practice.

Conclusions

Limitations of blood culture were perceived as a barrier to patient care. A rapid test to diagnose BSI would impact clinical practice, but the extent of impact may be limited by prevailing attitudes and practices. Opportunities exist for interventions to influence practitioners’ behaviors in BSI management particularly with emergence of newer diagnostic tests.     

Current Status of Echinoderm Genome Analysis - What do we Know?

Echinoderms have long served as model organisms for a variety of biological research, especially in the field of developmental biology. Although the genome of the purple sea urchin Strongylocentrotus purpuratus has been sequenced, it is the only echinoderm whose whole genome sequence has been reported. Nevertheless, data is rapidly accumulating on the chromosomes and genomic sequences of all five classes of echinoderms, including the mitochondrial genomes and Hox genes. This blossoming new data will be essential for estimating the phylogenetic relationships among echinoderms, and also to examine the underlying mechanisms by which the diverse morphologies of echinoderms have arisen.     

A Survey to Assess Family Physicians’ Motivation to Teach Undergraduates in Their Practices

Background

In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking.

Purpose

To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument.

Methods

The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation.

Results

A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern.

Conclusion

German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.     

How Much Ecology Do We Need to Know to Restore Mediterranean Ecosystems?

Despite important advances in ecological knowledge of Mediterranean‐type ecosystems, advances in restoration ecology have not seen a parallel increase in these systems. Although some concepts such as positive plant–plant interaction (facilitation) have received attention in the restoration ecology community, others such as phenotypic plasticity have not. Some concepts (e.g., environmental heterogeneity) are mature enough for a wide use in restoration, whereas available knowledge on others (e.g., facilitation, plasticity) is less conclusive. However, the scientific knowledge is in general enough to significantly improve the guidelines for restoration of Mediterranean ecosystems. Our review suggests that (1) the extent of facilitation in dry ecosystems is partially understood, with supporting, but somewhat contradictory empirical evidence for its potential use in restoration; (2) the influence of habitat heterogeneity on plant performance and plasticity is only beginning to be understood, with a strong bias toward patterns of structural heterogeneity and negligible information on functional heterogeneity; and (3) sound evaluations of phenotypic plasticity might be useful to increase the success of restoration practices in patchy Mediterranean environments. Future global change scenarios involving temperature rise, reduced precipitation, increased frequency of extreme climatic events, and important land use changes and fragmentation must be particularly considered when restoring Mediterranean ecosystems. Further research on how to incorporate results on facilitation, environmental heterogeneity, and plasticity within a global change framework is clearly needed.     

How Do We Know when Single-Molecule Force Spectroscopy Really Tests Single Bonds?

Single-molecule force spectroscopy makes it possible to measure the mechanical strength of single noncovalent receptor-ligand-type bonds. A major challenge in this technique is to ensure that measurements reflect bonds between single biomolecules because the molecules cannot be directly observed. This perspective evaluates different methodologies for identifying and reducing the contribution of multiple molecule interactions to single-molecule measurements to help the reader design experiments or assess publications in the single-molecule force spectroscopy field. We apply our analysis to the large body of literature that purports to measure the strength of single bonds between biotin and streptavidin as a demonstration that measurements are only reproducible when the most reliable methods for ensuring single molecules are used.     

Portuguese Family Physicians’ Awareness of Diagnostic and Laboratory Test Costs: A Cross-Sectional Study

Background

Physicians’ ability to make cost-effective decisions has been shown to be affected by their knowledge of health care costs. This study assessed whether Portuguese family physicians are aware of the costs of the most frequently prescribed diagnostic and laboratory tests.

Methods

A cross-sectional study was conducted in a representative sample of Portuguese family physicians, using computer-assisted telephone interviews for data collection. A Likert scale was used to assess physician’s level of agreement with four statements about health care costs. Family physicians were also asked to estimate the costs of diagnostic and laboratory tests. Each physician’s cost estimate was compared with the true cost and the absolute error was calculated.

Results

One-quarter (24%; 95% confidence interval: 23%–25%) of all cost estimates were accurate to within 25% of the true cost, with 55% (95% IC: 53–56) overestimating and 21% (95% IC: 20–22) underestimating the true actual cost. The majority (76%) of family physicians thought they did not have or were uncertain as to whether they had adequate knowledge of diagnostic and laboratory test costs, and only 7% reported receiving adequate education. The majority of the family physicians (82%) said that they had adequate access to information about the diagnostic and laboratory test costs. Thirty-three percent thought that costs did not influence their decision to order tests, while 27% were uncertain.

Conclusions

Portuguese family physicians have limited awareness of diagnostic and laboratory test costs, and our results demonstrate a need for improved education in this area. Further research should focus on identifying whether interventions in cost knowledge actually change ordering behavior, in identifying optimal methods to disseminate cost information, and on improving the cost-effectiveness of care.     

Factors Impacting Transgender Patients’ Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey

Background

Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.

Methods

433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via average marginal predictions, for transmasculine (n = 184) and transfeminine (n = 172) trans persons.

Results

Among the 83.1% (95% CI = 77.4, 88.9) of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77); transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15)). Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among transmasculine persons.

Conclusions

Within this transgender population, discomfort in discussing trans health issues with a family physician was common, presenting a barrier to accessing primary care despite having a regular family physician and “universal” health insurance.     

Continuing Medical Education—A Survey Among Physicians Practicing in San Diego and Imperial Counties

Patterns of continuing education of 244 physicians practicing in San Diego and Imperial Counties were studied by means of an interview questionnaire. An additional 20 internists and general practitioners were observed for one week in order to check the validity of the questionnaire findings.All physicians reported that they engaged in one or more means of continuing education and about three quarters had attended at least one formal course during the preceding three years. Almost all (99 percent) had attended some hospital-based teaching conference, tumor board or professional society meeting during the year preceding interview and 88 percent had attended at least once each month. Physicians in group practice participated more regularly in continuing education than those in solo practice, but no differences in participation were observed between those practicing in the metropolitan area of San Diego and those practicing in the other areas of the two counties. Different patterns of continuing education by specialty are also reported and the attitudes of physicians toward continuing education are described.     

Physicians’ Attitudes and Use of E-Cigarettes as Cessation Devices,North Carolina, 2013

Introduction

Electronic cigarettes (e-cigarettes) are not currently approved or recommended by the Food and Drug Administration (FDA) or various medical organizations; yet, they appear to play a substantial role in tobacco users’ cessation attempts. This study reports on a physician survey that measured beliefs, attitudes, and behavior related to e-cigarettes and smoking cessation. To our knowledge this is the first study to measure attitudes toward e-cigarettes among physicians treating adult smokers.

Methods

Using a direct marketing company, a random sample of 787 North Carolina physicians were contacted in 2013 through email, with 413 opening the email and 128 responding (response rate = 31%). Physicians’ attitudes towards e-cigarettes were measured through a series of close-ended questions. Recommending e-cigarettes to patients served as the outcome variable for a logistic regression analysis.

Results

Two thirds (67%) of the surveyed physicians indicated e-cigarettes are a helpful aid for smoking cessation, and 35% recommended them to their patients. Physicians were more likely to recommend e-cigarettes when their patients asked about them or when the physician believed e-cigarettes were safer than smoking standard cigarettes.

Conclusions

Many North Carolina physicians are having conversations about e-cigarettes with their patients, and some are recommending them. Future FDA regulation of e-cigarettes may help provide evidence-based guidance to physicians about e-cigarettes and will help ensure that patients receive evidence-based recommendations about the safety and efficacy of e-cigarettes in tobacco cessation.